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ILLINOIS SUMMIT ON ANTIMICROBIAL STEWARDSHIP 2015 Julie Sopocy, RN, BS, Director of Nursing Alden Estates of Barrington Skilled Nursing Facility Our Facility • Alden Estates of Barrington is 5 star rated facility that serves a unique population of skilled nursing needs. Our Population • 150 dual certified bed capacity. • Specialty – Ventilator/respiratory unit • Tracheostomy in place prior to admission to facility • Either long term care ventilator or attempting to wean • G-tube in place for enteral feeding if needed – Newly placed LVAD – Peripheral or Central lines for hydration or antibiotics. • Short term rehabilitation unit – Recent ortho surgeries – Rehab after CVA – Wound care – Post general surgical, weak due to illness • Long-term care unit – Home for 50% of residents Our Clinicians • Primary Care Physicians • Primary Care Nurse Practitioners • Pulmonologists • Infectious Disease • Nephrologists • Physiatrist • Wound Care Doctors • Psychiatrists • Podiatrists • Ophthalmologists Who defines Infection? • At our facility we use the McGeer’s1, 2 Infection Report Form for all suspected infections. 1Infect Control Hospital Epidemiology 2012;33:965-977 McGeer’s Criteria were developed as a surveillance tool to identify and report evidence of infections in Long Term Care Facilities and have not been validated as a clinical tool. These criteria have become the national regulatory standard that requires potentially infectious acute clinical changes be documented and communicated to physicians in a timely manner. 2 According to McGeer’s, any symptoms used to qualify defining infection must be: • New in onset or acutely worse • Rule out other causes first • Dehydration • New medication • Infection should not be identified by a single piece of evidence • Use microbial and radiology information When to Treat? • Infection report form helps define treatable infection • It is important to treat active infections, NOT asymptomatic colonizations • Use microbial studies to help determine active infection. • Infection report forms: – Respiratory tract – Urinary tract – Gastrointes tinal tract – Skin – Eye, ear, nose, mouth Barriers to Best Practice • Physicians: - use of prophylaxis treatment maintenance use for chronic infection treatment with broad spectrum antibiotics while a culture is pending not having qualifying diagnosis for use of foley catheters • Staff: - improper technique (hand hygiene, use of PPE, incontinent & catheter care) Overcoming Barriers • Education – To prescribers on criteria for antibiotic treatment and qualifying diagnoses for Foley Catheter use – To staff on proper hand hygiene, use of PPE with patients on precautions Overcoming Barriers • Communication – With prescribers: develop relationships with practitioners, call and ask for a culture or x-ray before treatment – With staff: – clinical rounds with interdisciplinary team and frontline staff twice daily to update on change of condition – use of interact tools; stop & watch, SBAR, care pathways. Overcoming Barriers • Observation – Quality Assurance rounds by a team of disciplines to assure procedures are being followed References • CDC – Centers for Disease Control, www.cdc.gov • SHEA, The Society for Healthcare Epidemiology of America, www.jstor.org • NIH, National Institute of Health, www.ncbi.nlm.nih.gov • Infect Control Hospital Epidemiology 2012;33:965-977